GuidingCare: Case Studies & Insights

The client, a national payer with Medicaid and Commercial lines of business, had targets to expand into new Medicaid markets but was beleaguered by operational limitations. The care management and utilization departments’ clinical workflows were heavily manual, as they had to work across seventeen disparate systems. Nurses couldn’t effectively access and update member records when in the member’s home, and several compliance gaps had been identified. The client had purchased HealthEdge®’s  GuidingCare® care management platform and hired a multi-billion-dollar consulting firm to plan and execute the implementation, but after several months the project was at a standstill, with the stakeholders unable to agree on the priorities for implementation.

Due to our track record of successful GuidingCare® implementations and our understanding of the business change approach needed for this platform, Anoteros was hired to replace the first consulting firm and we pivoted the project from a technology implementation to a clinical transformation for the payer. We worked to quickly understand the compliance and operational needs of the clinical teams and used that input to develop a phased implementation roadmap. The first release focused on a Minimal Viable Product (MVP), meeting the essential needs of all clinical teams and enabling the client to retain membership in their current market. Subsequent releases would add automation and efficiency gains, enabling the payer to expand into newer markets. We also mapped dependencies with the client’s other transformation initiatives and the GuidingCare® product roadmap. Instead of telling the stakeholders what they should do, we worked to understand their needs and concerns and used that to inform the roadmap. With all stakeholders now on board, the client – with Anoteros’ help – was able to move forward with implementation.

The transformation consolidated clinical operations from seventeen systems to one, automated key clinical workflows, provided mobile capability for nurses’ home visits, and enabled payer-provider collaboration using portals. As a result, the plan was able to reduce its compliance gaps by 75% and increase staff productivity by 40%. These improvements enabled the payer to secure its current market position and expand into new markets. The client called Anoteros “the key reason for the successful transformation of their clinical operations.”

The client, a health plan offering Medicaid plans in the Midwest, had launched the implementation of HealthEdge®’s GuidingCare® platform. Unlike its legacy care management system, GuidingCare® would allow integration with other applications, workflow automation, and importantly, the ability to easily scale and therefore support the health plan’s goal of expanding into new markets. Unfortunately, the legacy system vendor was not willing to participate in this transition and instead opted to provide raw data extracts of the client’s clinical records without documentation on the data model.

Anoteros was hired to migrate the data from the legacy system to GuidingCare®. We tapped into our deep healthcare payer experience, knowledge of care management, and expertise in data and technology. We brought together a team of data and business analysts, developers, and a project manager. The team hit the ground running, quickly learned the data model of the legacy system, and developed a data migration and archival strategy. The strategy not only included the steps to migrate data into GuidingCare® but also included steps to address the front-end and workflow impacts once the data was migrated into GuidingCare®. Our team created the data mapping specifications, developed the data migration routines, performed system testing, and facilitated the user acceptance testing of the migrated data in GuidingCare®.

The data migration was successful and supported a seamless transition between care management platforms for the end-users. The data archival strategy positioned the health plan to easily respond to future audits. Overall, the data migration allowed the client to complete the implementation project and turn their focus to expansion efforts.